Healthcare Provider Details

I. General information

NPI: 1316154289
Provider Name (Legal Business Name): TAMADOR S GIBREEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 LENOX STREET
SPRINGFIELD MA
01108
US

IV. Provider business mailing address

15 LENOX STREET JEWISH FAMILY SERVICES
SPRINGFIELD MA
01108
US

V. Phone/Fax

Practice location:
  • Phone: 413-746-2001
  • Fax: 413-746-2024
Mailing address:
  • Phone: 413-746-2001
  • Fax: 413-746-2024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGPC200001518
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: